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These scales can coa- hot moist compresses and massage may be effective lesce and act as a constricting band 100 mg pristiq mastercard. More ad- dispose the bird to bacterial pododermatitis (usually vanced lesions require surgical intervention generic pristiq 100mg. If present order 100mg pristiq fast delivery, the shiny cheap 100mg pristiq with mastercard, convex cumferential indentation is treated using magnifica- carapace of the female Knemidocoptes mite can usu- tion to remove the constricting tissue (Figure 41. In most A tourniquet fashioned from a rubber band held instances, lesions resolve after treatment with iver- tightly with a mosquito hemostat may be used to mectin or correction of nutritional deficiencies. In control hemorrhage for short periods until the injury severe cases, it may be necessary to surgically de- is properly treated. Hemostatic agents including ra- bride the proliferative scales to prevent vascular diocoagulation should be avoided. A 22 or 25 ga needle with the point bent to the digits is minimal, and anything that interferes to a 90° angle can be used to lift the scales and scabs, with proper blood flow may predispose the digit to which can then be grasped with the micro-forceps. A circumferential anastomosis of the skin is then performed by placing one or two sutures in the sub- Toe Necrosis (Constricted Toe Syndrome) cutaneous tissues to provide skin apposition without Avascular necrosis of digits may occur secondary to tension. Skin sutures should be placed shallow below circumferential constriction caused by fibers, scabs the epidermis and be sufficiently tight to appose the or necrotic tissue (see Color 24). Su- cause edema and if untreated, sloughing of the digit tures placed too deeply will cause the skin edges to distal to the constriction. This condition is generally4 evert, exposing subcutaneous tissue and delaying not life-threatening, and amputation should be con- healing. When the skin edges are apposed, a two to sidered only after less aggressive therapies have three millemeter release incision should be made at failed. Removal of the offending tissue or fibers and the site of the anastomosis on both the lateral and supportive care are frequently successful. These incisions allow necrosis of the digits has been described in passerine swelling without constriction. Scabs should be debrided is applied to prevent scab formation, which could or incised to prevent vascular compromise, and hy- result in reformation of the constriction. Feather Cysts follicle, feather growth becomes asymmetrical and the feather may grow in a curled fashion inside the Feather cysts are generally the result of trauma to follicle, resulting in a feather cyst. Fulguration with a radiosurgical unit has been reported to be successful Feather cysts may occur within any feather follicle, in some cases; however, the depth of destruction is but those on the wing and tail are the most challeng- difficult to control, resulting in damage to adjacent ing to the surgeon. These damaged follicles can then develop common in Norwich, Gloucester and their cross- feather cysts. These birds have been genetically selected to appear to improve the long-term clinical results. The feather development have been associated with entire follicle, including any bony attachments, trauma, malnutrition and viral, bacterial or parasitic should be excised. As adjacent feathers begin Xanthomatosis is characterized by the deposition of to regrow, debris should be gently removed by flushing a rubber-like proteinaceous material within the skin with warm sterile saline several times daily. Xanthomas at the With a single cyst or a large feather, the follicle may wing tip may cause the wing to droop, resulting in be saved by marsupializing the lining of the cyst with trauma to the mass. An incision is made Amazon parrot) and dietary management should be centered on the cyst, parallel to the direction of used in combination with surgical excision of the feather growth. Redun- els should be closely monitored because they are dant tissue is excised and the follicle is thoroughly usually elevated in birds with xanthomatosis and lavaged with sterile saline. The margin of the cyst is should be medically reduced to a normal level prior then sutured to the skin using a simple continuous to surgery. A monopolar, wire electrode functions well for re- Feather cysts of the tail may be severe and disfigur- moval of xanthomatous masses. The wound may be pro- dissection to the coccygeal vertebrae allows disar- tected with tissue adhesive or a hydroactive dress- ticulation at the sacrococcygeal junction without en- ing, which should be changed every three to five tering the cloaca. If subcutaneous tissues are involved (especially Feather cysts on the body are easily removed using bone), the affected wing may require amputation. A technique for radical exci- Impaction of the uropygial gland may respond to sion of an entire pteryla of affected feathers in canar- medical management using hot, moist compresses ies has been described. In some cases, from the flank to the thoracic inlet around the af- the gland may rupture, causing inflammation and fected pteryla. The main vascular supply to the tract scar tissue formation in the surrounding tissues. Removal of one or more ptery- A fusiform incision is made along the dorsal midline lae from the body wall does not seriously affect the to incorporate the papillae of the gland. The gland may extend deeply to Feather cysts may occur secondary to any factor that dam- the synsacrum and caudally to the insertion point of ages the follicular epithelium. The vessels are identified and co- For feather cysts on the wing, blade excision appears to be the treatment of choice. Bipolar coagulation should be Feather cysts of the tail may require amputation of the used to minimize damage to the follicles of the rec- pygostyle. Dissection is continued, beginning at the cra- Feather cysts on the body are removed using elliptical or nial extent of the gland proceeding circumferentially fusiform excision followed by primary skin closure. Standard Extensive dissection and debridement are necessary if ulcer treatment is instituted postoperatively. An additional caudal incision corneal surface will re-epithelialize from the limbus. Surgery of the Eye In a study of older macaws, immature cataracts were present in at least one eye of most birds over the age of 35. The change from an incomplete, immature cataract progressed rapidly to a complete, mature Idiopathic paralysis of the inferior eyelid occurs with cataract seemingly skipping a complete, immature some degree of frequency in cockatiels and occasion- stage. Those birds with rapidly developing cataracts ally in Umbrella Cockatoos (see Color 26). A lateral For lens removal in these macaws, no attempt was canthoplasty will create a smaller aperture, reducing made to dilate the pupil preoperatively. The macaw the risk of exposure keratitis and associated condi- cornea is approximately seven millimeters in diame- tions (Figure 41. These may be the sloughing of the corneal epithelium were reported result of tissue edema, cyst formation or discrete complications; however, postoperative inflammation masses. These masses may be secon- dary to chlamydiosis, mycoplasmosis, eyelid paralysis Ten of the 13 eyes were visual after surgery. One bird or oropharyngeal abscessation from hypovitaminosis had bilateral posterior synechiae and pigment mi- A (see Chapters 22, 26). A third eye remained blind because of a pre-existing intraocular inflamma- tion that caused a change in consistency of the lens Indolent Corneal Ulcers 7 material and retention of the lens protein. Successful treatment of indolent corneal ulcers in Ultrasonic phacoemulsification may be successful in birds appears to require debridement of the entire removing the lens of birds with large eyes (such as superficial layer of the cornea. A thin strip of eyelid is removed for a distance approximately one-fourth the total eyelid length. Monofilament nylon sutures (8-0 to 10-0) are placed in a simple interrupted pattern.

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Ultra-Violet Spectrophotometer was used to determine the rat’s serum lipid levels cheap pristiq 50mg without a prescription. Significant antihyperlipidemic effect was found with both aqueous and ethanolic extracts of P discount 50 mg pristiq overnight delivery. Various parts of the plant such as leaves 100 mg pristiq, roots pristiq 100mg generic, seeds, barks, flowers and immature pods are being employed for antitumor, antipyretic, antiepileptic, anti- inflammatory, antiulcer, antispasmodic, diuretic, antihypertensive, antioxidant, antidiabetic, hepato-protective, cholesterol lowering, antibacterial and antifungal activities in the indigenous system of medicine. The purpose of the present study is to evaluate the antihyperglycemic effect of the leaves of Moringa oleifera Lam. For evaluation of antihyperglycemic effect, the doses of crude aqueous extract (1. Ninety-five percent ethanolic extract (3g/kg and 6g/kg) showed significantly antihyperglycemic effect at 2hr (p<0. Comparison of antihyperglycemic effects between different doses of extracts and glibenclamide showed that both extracts and glibenclamide have antihyperglycemic activities but percent inhibition of glibenclamide was superior to crude extracts. The antihyperglycemic effect of crude extracts had late onset and short duration of action than glibenclamide. The acute toxicity study of aqueous extract and 95% ethanolic extract were performed by using albino mice. The result indicated that there was no lethality up to maximum permissible dose of 12g/kg in both extracts. Phytochemical and physicochemical analyses were also conducted by using reference analytical procedures for quality control of leaves materials of Moringa oleifera Lam. Flavonoid compound, quercetin which is known to have antihyperglycemic activity was qualitatively isolated by using Preparative Thin Layer Chromatography from acid hydrolysed extract of the leaves of Moringa oleifera Lam. The isolated compound was identified by Thin Layer Chromatography, Ultraviolet Spectroscopy and Fourier Transform Infrared Spectroscopy. These investigations were performed to find out whether the extracts of Zingiber officinale Roscoe. In order to study the anti-inflammatory action of both aqueous and ethanolic extract of Zingiber officinale Roscoe. Anti-inflammatory action of both extracts was investigated by using three doses levels i. Significant anti-inflammatory action was found with both aqueous and ethanolic extract of Ginger. It was found that the anti-inflammatory action of ethanolic-extract started to appear with the dose of 0. The results also indicated that the anti- inflammatory action of ethanolic extract of Zingiber officinale Roscoe. However, anti-inflammtory actions of both aqueous and 50% ethanolic extracts of Ginger (3g/kg) were inferior to that of standard reference drug acetylsalicylic acid (i. The results indicate that there was no lethality up to 3g/kg body weight with both aqueous and 50% ethanolic extract. General pharmacological screening test of both aqueous and ethanolic extracts of Ginger on albino rats has shown no abnormal changes. The phytochemistry of the extracts showed that the aqueous extract contained saponins, alkaloids, tanninoids, flavonoids, steroids and the 50% ethanolic extract contained saponins, alkaloids, resin, tanninoids, flavonoids and steroids. It was observed that anti-inflammatory action of both extracts of Zingiber officinale Roscoe. It was found that anti-inflammatory action of 50% ethanolic extract of Ginger 3g/kg was (0. It is a major cause of death in young adults following Human-immunodeficiency virus epidemic and emergence of multi-drug resistant strains of mycobacteria. Hence, there is a clear need to develop new and effective drugs for management and control of tuberculosis. Soxhlet assembly for extraction and rotatory evaporator were used to get solvent-free plant extracts. Among the biologically active plant extracts screened as mentioned above, alcoholic extract of Lauk-they had the highest biological activity and it was evaluated for anti-mycobacterial activity by using in vitro method. Effects of various concentrations of alcoholic extract of Lauk-they on different isolates of Mycobacterium tuberculosis were tested in vitro, both qualitatively and quantitatively. These effects were compared with those of minimal inhibitory concentrations of isoniazid and rifampicin. Lauk-they was found to have anti-mycobacterial activity at 72mg/ml concentration even on strains resistant to isoniazid and rifampicin. Phytochemical analysis of Lauk-they alcoholic extract showed that it contained alkaloids, flavonoids, triterpene steroids and tannins. No acute toxicity was found in this study and median lethal dose of Lauk-they was assumed to be above 1g/kg concentration. The parent and its metabolite N4-acetylsulphadimidine elimination half-lives, deduced from their time profiles of plasma and urine, were monitored spectrophotometrically. The seeds under investigation revealed no significant effect on any of the pharmacokinetic criteria, regarding hepatic acetylation or renal excretion in either of the phenotypes. In order to study the hypotensive action of the aqueous extract of Moringa olifera Lam. The blood pressure recording method used throughout the present work was kymographic method. The extract had also effect on isolated heart, isolated intestinal smooth muscle, isolated aortic strip, vascular smooth muscle of rabbit ear and bilateral carotid occlusion reflex. Phytochemical analysis showed presence of flavonoids, glycosides, amino acids, tanninoids and phenolic compounds as organic constituents, and iron, sodium, potassium, magnesium and sopper as inorganic constituents. The results were discussed with regards to possible mechanism of action of Moringa olifera Lam. May Aye Than; Mu Mu Sein Myint; Ohnmar Kyaw; Moh Moh Htun; Khin Taryar Myint; Phyu Phyu Win; San San Myint; Nu Nu Win; Thandar Myint. Thus, the aim of this study was to extract of Bizat was physicochemically and phytochemically standardized by using the methods for it herbal pharmacopoeia. Glycoside, polyphenol, flavonoid, steroid, terpene carbohydrate, saponin, protein, resin and reducing sugar were present. The blood and liver tissue were collected for biochemical and histological assessment of liver damage. The serum enzyme activities and histological appearance of degeneration, necrosis and fibrosis were no significant difference between aqueous extract protected and unprotected groups. Study of the utilization pattern of traditional medicine on the management of malaria. This study was undertaken in 5 townships (Bago, Daik-U, Kyauk-ta-ka, Tharyarwaddy, Oke-Po in Bago Division to determine the use of modern drugs and traditional medicine for malaria. Five hundred and seven respondents with history of malaria fever during the last 3 months were face to face interviewed. Qualitative information was collected through informal conversation with shop owners, interviews with traditional healers, persons with history of malaria fever and focus group discussions with community members. Traditional drugs use included packets with antipyretics (59%), packets with traditional medicine (22.

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General: alert buy pristiq 50 mg amex, oriented × 3 buy cheap pristiq 50 mg on line, in distress because of pain and mild shortness of breath b purchase pristiq 100mg free shipping. Lungs: diminished breath sounds at left base discount 50 mg pristiq with amex, + crackles, dull to percussion, normal breath sounds right lung 250 Case 58: sickle-Cell Disease Figure 58. Extremities: no deformity, normal pulses, + pain to range of motion of left shoulder, right upper and bilateral lower extremities with full range of motion n. This is a case of acute chest syndrome in a sickle-cell patient, a condition of unclear etiology thought to be caused by infection or lack of oxygen supply to the lung tissue that can lead to respiratory failure and death. This is a more seri- ous diagnosis than the more common pain crises, and can lead to rapid dete- rioration of respiratory status. Symptoms that identify acute chest syndrome are chest pain, respiratory complaints, fever, or cough. Curveball: the nurse approaches the candidate and states, “This guy is here all the time, and complains about pain here or there until he gets his fx of narcot- ics. Rapid identifcation of painful crises that are not typical of the patient’s usual symptoms should elicit a search for more serious complications of sickle cell including acute chest, aplastic crisis, splenic sequestration, hemolytic crisis, serious infection, stroke, or other end-organ infarct. Patient appears stated age, somewhat lethargic, appears ill, responding slowly to questions. He did not want to come to the hospital, but his roommate insisted when he developed a fever and was “not very awake. Not the worse headache of life but signifcant pain, not sudden onset or thunderclap, no nausea, vomiting, blurry vision; + photophobia, + neck pain. Eyes: extraocular movement intact, pale conjunctivae, + photophobia, equal and reactive pupils, unable to visualize fundus d. Sent for Gram stain, culture, cell count, glucose, protein Case 59: Headache 255 Figure 59. This is a case of bacterial meningitis, a serious infection of the tissues surround- ing the brain and usually fatal if not treated promptly. Classic symptoms are headache, fever, neck stiffness, and a petechial or purpuric rash. If steroids are given, they should be administered Case 59: Headache Case 60: Chest Pain 257 before or with the antibiotic. The candidate should isolate the patient early in the course of the case and get in contact with college heath services regarding prophylaxis of students and staff for meningitis. Petechial/purpuric rash in the setting of headache and fever is suffcient to begin treatment. Kernig’s(contractionofhamstringsinresponsetokneeextension)orBrudzinski’s (fexion of hips/knees in response to neck fexion) signs are often unreliable but may aid in the diagnosis. Patient appears stated age, alert, oriented × 3, sitting up on stretcher, in no acute distress. The pain is localized to the mid chest, and is sharp, nonradiating, worse with inspiration. If asked, he reports it is made worse with lying down, and made better by sitting forward. If asked about recent illnesses, he states that he had “a cold” about a week ago that resolved on its own; no recent travel; no swelling or pain in leg. General: alert, oriented × 3, sitting forward on stretcher, in no acute distress Figure 60. Heart: friction rub is heard over the left apex (must ask), normal rate and rhythm k. Often caused by viral illnesses or idiopathic, it is not an acute coronary syn- drome, and rarely requires admission. Once the candidate diagnosis pericardial effu- sion, the patient should be admitted for observation and management to watch for cardiac tamponade. The candidate should still consider other differentials such as pulmonary embolism or myocardial infarction by reviewing risk factors such as family history of cardiac disease and recent travel history. Pericarditis may be caused by viral or bacterial illnesses, malignancy, radia- tion, or a variety of other causes. Patients often present with chest pain, made worse with lying down and improved with sitting forward. Additional symptoms can include dysphagia, dyspnea, and intermittent low-grade fevers. A friction rub heard over the left side of the chest is the most frequently encountered physical fnding. Test such as laboratory tests, chest radiographs, and echocardiogram can aid in ruling out other causes of chest pain. Patient appears stated age, confused, garbled response to questions, with obvi- ous facial droop on right side. She has a history of hyperten- sion, high cholesterol, diabetes, and hypothyroid disease. She suffers from mild dementia and forget- fulness, but is otherwise active, walks frequently, and is usually alert and con- versational. Upon questioning she states she took her regular medications but did not eat breakfast because she had a doctor’s appointment at 1 p m. If D50 is not given, patient will continue to be confused with focal neurological fndings c. No dextrose – patient remains confused Case 61: Altered Mental status 263 Figure 61. Eyes: pale conjunctivae, extraocular movement intact, pupils equal, reactive to light d. No dextrose – facial droop with garbled speech, does not cooperate with examination, refexes normal, Babinski refex normal, withdraws to pain q. Option 3: octreotide 50 to 125 mcg subcutaneously Case 61: Altered Mental status 265 b. This is a case of altered mental status with neurological defcits as a result of hypoglycemia. Hypoglycemia (low blood glucose) can mimic stroke syndromes presenting with weakness and confusion, and can typically be reversed with the administration of dextrose. The hypoglycemia in this scenario is due to not eating breakfast after taking a diabetes medicine (glipizide, a sulfonylurea). Obtaining an immediate blood glucose level is crucial to the diagnosis in this case. With the ingestion in this case, further action is required beyond a rapid correction of blood glucose with dextrose in the case. Blood sugar levels must be maintained because sulfonylurea drugs can cause delayed or rebound hypoglycemia for many hours. Feeding fuids with dextrose, or octreotide are all adequate options for this, with two or all three sometimes required. Symptoms of hypoglycemia are due to both the effects on the brain and a refex sympathetic surge. Neurological effects include confusion, altered mental sta- tus, agitation, unresponsiveness, and symptoms that may mimic acute stroke such as focal neurological defcits.

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In the ideal situation buy pristiq 50 mg fast delivery, the same process with the same patient would always result in the same performance pristiq 100mg mastercard, so that the same meaning might be attributed to the same scores – whether from one pa- tient to another or from one examination to another trusted pristiq 50 mg. Some collections of tests (often termed batteries) such as the Wechsler Adult Intelligence Scales (which is updated about every 15 years) or the Halstead-Reitan Battery (which has remained unchanged for decades) contain different tasks for examining a number of cognitive dimensions (8 order pristiq 50 mg online,9). In the past, scores for these different tests were summed into one or several scores, presumably communicating something about the ephemeral concept “intelligence”, or the presence of a brain disorder. However, current knowledge of the complexities of brain function have rendered these summation procedures obsolete (4). Most individual tests actually examine a number of functions – not least being the ability to un- derstand instructions or keep them in mind. A drawing task, for example, in examining the ability to copy a design, will provide information on the patient’s fine motor control, visuospatial orientation, visual concept for- mation, perceptual accuracy, attention to details, among other capacities. Comput- erized tests are now available in which items are always delivered in the same format, automatic scoring takes into account reaction times and re- sponse delays, and the data are automatically recorded and evaluated. The main strengths of psychometric tests are their precision, their re- liability, and their generally good construct validity which allows examin- ers to generalize from test data to real-life predictions. Their chief limita- tions include difficulty in interpreting scores generated by tests of com- plex behaviors (e. Test users must realize that reliance on test scores alone loses very important qualitative aspects of patients’ per- formances; e. Significant idiosyncrasies of speech and pragmatics will al- so remain undocumented. Moreover, the development, standardization, and validation of a new test takes a long time – around ten years on aver- age – yet knowledge about cognition advances more rapidly. By missing a critical component discovered after their development is underway, some tests may be out of date even before their publication. Clinical scales and symptom inventories derived from classical neu- rology are also used for assessing impairment, both cognitive and behav- ioral. Tasks and items are designed to elicit data specific for one or an- other pathological symptom or syndrome. Since symptoms are not nor- mally distributed in either the patient or the general population, the usu- al normative approach is not relevant to standardization. For instance, the well-known Boston Diagnostic Aphasia Examination (11) is a standardized and quantitative examination of aphasia signs, not a test of language skills. Clinical scales are often used in preliminary investigations to be supplemented, as needed, by more spe- cific tests. Cognitive neuropsychology has also devised methodologically sophis- ticated research protocols that can identify specific cognitive functions. Using similar methods, relationships between brain structures or brain pathology and highly specific cognitive functions or dysfunctions have al- so been elucidated. To identify specific cognitive functions – or dysfunc- tions, this methodology requires two or more tasks with known properties in a cognitive domain. For example, if two cognitive functions A and B are independent (for instance, reading words aloud via a direct, lexical route, or reading via a grapheme/phoneme conversion process in a phonological route) it should be possible to find two tasks X and Y (in this example, reading aloud non-words and reading irregular words) such that success on task X and failure on task Y would be characteristic of the impairment of A and of the integrity of B; and conversely, success on Y and failure on X would be characteristic of the impairment of B and the integrity of A. Rather, the assessment is tailored for each patient, with tasks improvised accord- ing to the hypotheses to be tested. Selective attention, working memory, written language, visual perception, and agnosia in stroke patients are some of the domains in which this kind of procedure has proven fruitful. Advantages are coherence with theoretical models and refined under- standing of the specificity and brain relationships of many cognitive func- tions – and disorders, which had proven useful for therapy. However, this complex and time-consuming methodology, while important for research, has poor ecological validity, i. Questionnaires, checklists, and rating scales based on observation or in- terview are the most usual forms of assessment. Self-administered questionnaires ask patients for their opinions about their own abilities and behavior. These questionnaires have the ad- vantage of documenting self-awareness and the extent to which patients perceive their own limits with regard to cognitive skills. Conversely, they may not provide an objective or accurate account of the patient’s cogni- tive status. Items commonly included in such scales deal with abilities to read and write documents (e. Other items inquire about the patient’s self-sufficiency at home, such as taking prescribed medications without help or managing money (e. The Catherine Bergego Scale, which addresses the difficulties that pa- tients with unilateral inattention (neglect) are faced with in daily living is another example (14). Communication abilities, which are often impaired in brain damaged patients, need specific assessments. Recently these au- thors developed the Bordeaux Verbal Communication Scale, an ordinal scale rated from a structured interview, to document the efficacy of the aphasic patient’s communication in daily living and social activities: e. Some disability scales are scored according to the degree and type of help needed to per- form the task, which provides useful data for planning services (e. It is the visible product of the interaction between the person and the envi- ronment in a given situation. So it depends on many parameters, such as speed and accuracy in processing information coming from the external world, mental states about the situation (degree of awareness, affect, mo- tivation), previous goal-directed schemes and life styles (influence of cul- ture, education, previous experiences), and, of course, attitudes and reac- tions of other persons participating in the situation. Obviously it would be impossible to create an assessment tool which would take into account all these parameters. So behavioral assessment is necessarily global and de- scriptive, as is disability assessment. Questionnaires, check lists, and ordinal scales include brief descriptions of symptoms or behaviors that may be observed during the course of the condition, or lists of behaviors consid- ered abnormal with respect to social standards or compared to premor- bid behavior. More recently devel- oped scales contain many more behavioral tasks with graduated scores in- dicating task difficulty and degree of patient independence. The fine gra- dations of some instruments may permit the data to be treated much as scales with continuous variables (16, 18). Some ask for reports on correct or usual behaviors, which immediately raises the major questions: what is normal behavior? Many check lists ask for frequency or severity data for each item which gives quantifiable data for ordinal scaling. The goal of these instruments is to be more comprehensive by gathering cognitive, af- fective, and behavioral data in the same interview. Like cognitive ability scales, it developed mostly under the influence of rehabilitation medicine and pragmatic inquiry into the ecological validity of classical testing: e. And to what extent are the memory processes involved in a test the same as those required for everyday activities? Despite a general relationship be- tween memory test scores and daily functioning (4), good scores do not necessarily predict satisfactory behavioral adjustment or ability to return to work.

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